Global rarity of intact coastal regions.

Management of the land-sea interface is essential for global conservation and sustainability objectives because coastal regions maintain natural processes that support biodiversity and the livelihood of billions of people. However, assessments of coastal regions have focused strictly on either the terrestrial or marine realm. Consequently, understanding of the overall state of Earth's coastal regions is poor. We integrated the terrestrial human footprint and marine cumulative human impact maps in a global assessment of the anthropogenic pressures affecting coastal regions. Of coastal regions globally, 15.5% had low anthropogenic pressure, mostly in Canada, Russia, and Greenland. Conversely, 47.9% of coastal regions were heavily affected by humanity, and in most countries (84.1%) >50% of their coastal regions were degraded. Nearly half (43.3%) of protected areas across coastal regions were exposed to high human pressures. To meet global sustainability objectives, all nations must undertake greater actions to preserve and restore the coastal regions within their borders.

costa, huella humana, impacto humano cumulativo, litoral, presión humana, restauración, tierras vírgenes Resumen El manejo de la interfaz entre la tierra y el mar es esencial para los objetivos mundiales de conservación y sustentabilidad ya que las regiones costeras mantienen los procesos naturales que sostienen a la biodiversidad y al sustento de miles de millones de personas. Sin embargo, los análisis de las regiones costeras se han enfocado estrictamente en el ámbito marino o en el terrestre, pero no en ambos. Por consiguiente, el conocimiento del estado general de las regiones costeras del planeta es muy pobre. Integramos la huella terrestre humana y mapas marinos del impacto humano cumulativo en un análisis global de las presiones antropogénicas que afectan las áreas costeras. De las áreas costeras de todo el mundo, el 15.5% tuvieron una presión antropogénica reducida, principalmente en Canadá, Rusia y Groenlandia. En cambio, el 47.9% de las regiones costeras estuvieron fuertemente afectas por la humanidad, y en la mayoría de los países (84.1%) >50% de sus regiones litorales se encuentran degradadas. Casi la mitad (43.3%) de las áreas protegidas en las regiones costeras tienen un grado de exposición a fuertes presiones humanas. Para cumplir los objetivos mundiales de sustentabilidad, todos los países deben emprender mejores acciones para preservar y restaurar las regiones litorales dentro de sus fronteras.

Multinational coordination required for conservation of over 90% of marine species.

Marine species are declining at an unprecedented rate, catalyzing many nations to adopt conservation and management targets within their jurisdictions. However, marine species and the biophysical processes that sustain them are naive to international borders. An understanding of the prevalence of cross-border species distributions is important for informing high-level conservation strategies, such as bilateral or regional agreements. Here, we examined 28,252 distribution maps to determine the number and locations of transboundary marine plants and animals. More than 90% of species have ranges spanning at least two jurisdictions, with 58% covering more than 10 jurisdictions. All jurisdictions have at least one transboundary species, with the highest concentrations of transboundary species in the USA, Australia, Indonesia, and the Areas Beyond National Jurisdiction. Distributions of mapped biodiversity indicate that overcoming the challenges of multinational governance is critical for a much wider suite of species than migratory megavertebrates and commercially exploited fish stocks-the groups that have received the vast majority of multinational management attention. To effectively protect marine biodiversity, international governance mechanisms (particularly those related to the Convention on Biological Diversity, the Convention on Migratory Species, and Regional Seas Organizations) must be expanded to promote multinational conservation planning, and complimented by a holistic governance framework for biodiversity beyond national jurisdiction.

Assessing need for pharmacist involvement to improve care coordination for patients on LAI antipsychotics transitioning from hospital to home: A work system approach.

BACKGROUND: The use of Long-Acting Injectable (LAI) antipsychotic medications has increased for patients with Serious Mental Illness (SMI). Care coordination for this population is complex, and pharmacist involvement may improve and support long-term medication adherence and patient outcomes. OBJECTIVES: (1) Examine pharmacists' role in addressing care coordination and adherence challenges for patients taking Long-Acting Injectable (LAI) antipsychotics; and (2) explore patients' medication use experiences with LAI antipsychotics and educational needs. METHODS: This project utilized a holistic work systems approach to assess the usefulness of implementing a pharmacist-led intervention to improve care coordination for patients taking LAI antipsychotics. Data collection and analyses were guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model. Data were collected using interviews with healthcare team members and patients taking LAI antipsychotics and retrospective chart reviews at a psychiatric hospital in Southwestern Pennsylvania. Data collection elicited information about LAI care coordination, the pharmacist's role, and patients' experiences. Content and thematic analyses were conducted to identify opportunities to improve quality of care and patient outcomes. RESULTS: Sixteen healthcare team members and six patients were interviewed. Twenty patient charts were reviewed to examine the care coordination process. Four themes of the workflow process emerged: pharmacist consultation, in-hospital LAI administration, discharge planning, and outpatient treatment. Key challenges identified included inadequate communication, limited knowledge, and the need for standardized roles. Most patients did not know the name of their LAI antipsychotic and did not recall receiving medication counseling, but were interested in discussing medication concerns with pharmacists. CONCLUSIONS: There is a need for improved communication during LAI care coordination, targeted education for healthcare team members, and standardization of roles. Many patients did not have adequate LAI antipsychotic knowledge or receive appropriate medication counseling. Increased pharmacist involvement in the care coordination process may promote adherence and optimal management of SMI.